Provider First Line Business Practice Location Address:
1134 CHAPMAN LAKE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JERMYN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18433-3145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-254-6495
Provider Business Practice Location Address Fax Number:
570-254-6495
Provider Enumeration Date:
11/06/2006